Villa Sorrento

Type of visit: Required - 1 Year

On May 8, 2025, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with Executive Director Carla Chan. LPA explained the purpose of today’s visit. The facility is licensed to serve ambulatory and non-ambulatory elderly adults ages 60 and above. The facility is approved for (15) hospice residents. Currently, the facility has (5) residents on hospice care. The facility is a two-story structure located in a commercial neighborhood. It consists of the following: (108) resident bedrooms. Each room has a bathroom in the unit. The facility houses an activity room, dining area, kitchen, beauty shop, administrative offices, and outside patio area. LPA toured the physical plant. There were no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, and storage for the resident's personal belongings was observed. Bathrooms were found to be within Title 22 regulations and were operational. LPA inspected rooms: #111; #113; #127; #135; #138; #141; #207; #212; #217, and #224. The water temperature range from 105.0 - 106.9 degrees F. and room temperature range from 74 - 75 degrees F., call buttons, and smoke and carbon monoxide are all in operating condition. LPA observed the facility to be sanitary and appropriately furnished at the time of the visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is sufficient perishable and non-perishable food available maintained properly. All fire extinguishers were charged. A review of Fire & Earthquake Drills were completed for AM, PM and NOC shift on 04/01/25 and 04/04/25. Several working landline phones are available on-site. A review of Medication Administration Records found to be in order and accurate. Evaluation Report continues on LIC 809C During the visit LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas and restrooms. All mandated inspection control posters, including the Activities Calendar and Food Menu, were posted. The facility included stairway evacuation chairs in all the stairwells. An audit of resident's service records for resident #1-#6 (R1-R6) and staff personnel records for staff #1-#6 (S1-S6) were accurate and complete. The facility is current on Community Care Licensing annual fees. The facility has a current administrator certificate on file for Chan Carla #7001104740 05/04/2023 through 05/03/2025 RCFE. The facility has a Liability Insurance Certificate valid with policy # 01341969 effective 03/01/25 through 03/01/2026. No Deficiencies were identified during this inspection visit. An exit interview was conducted, and a copy of this report was provided to Carla Chan.the state’s words, verbatim · CDSS document, May 8, 2025

Allegation investigated: Facility is overcharging resident for rent.

On 01/29/2025, the department conducted an unannounced compliant visit to the facility listed above. The department met with Executive Director, Carla Chan and the purpose of today’s visit was explained. During the initial visit on 12/31/2024 the department toured the facility, interviewed Staff S1-S3, interviewed Residents Responsible Party W1-W2, and received documents pertinent to the investigation. The following documents were received and reviewed, Staff Roster, Resident Roster, list of Assisted Living Waiver Residents, Billing Spread Sheet, Resident Admission Agreement, Resident Billing Statement, Resident Assisted Living Waiver Informing Notice, Resident Certification of Admission to Social Security Administrator, and Addendum to Resident Admission Agreement for rent increase. During a subsequent visit on 01/16/2025 the department toured the facility, interviewed Residents R3-R6, and received additional documents. The following documents were received and reviewed, Resident Emergency Identification Form and Billing Spread Sheet. The investigation revealed the following: Unsubstantiated Allegation: facility is overcharging resident for rent. The complaint allegation alleges that the facility is charging residents over the SSI/SSP amount. During record review at the facility, the department received and reviewed R1’s Admission Agreement that states the basic services monthly rate is $1,398.07 and was agreed upon by the Responsible Party. According to the Non-Medical Out-Of-Home Care (NMOHC) Payment Standard for Individual-Licensed Facility the amount payable for Basic Services is $1,398.07. Additionally, in the Admission Agreement on page 10, the department reviewed the Addendum To Monthly Rate Increases, that states “on or before January 31st of each year, this facility shall prepare documents disclosing its average monthly rate increase at the average percentage of increase, for the service fee.” The addendum was signed and agreed upon by R1’s Responsible Party on 05/21/2024. The department received and reviewed the notice provided to R1’s Responsible Party regarding the rate change for 2025 to the amount of $1,420.07 for amount payable for Basic Services. Which is the current NMOHC Payment Standard for individuals in licensed facilities. The department additionally received and reviewed a copy of the Monthly Payment Log for December and January and observed residents who are part of the Assisted Living Waiver Program pay the amount payable for basic services. During interviews with Staff S1-S3, were asked if there are any residents who are on the Assisted Living Waiver Program and use their SSI to pay the difference pay more than the amount payable for basic services, three (3) out of three (3) stated residents do not pay more than the amount payable for basic services which is $1,398.07. Additionally, during interviews with staff S1-S3, the department was informed the first notice they provided to Residents, or their Responsible Party had the incorrect amount listed on the notice. The amount listed was the NMOHC payment standard and not the amount payable for basic services. Staff S1-S3 stated when they realized the error they began calling residents to verbally inform them of the error and provide the correct amount. They additionally created a new notice to provide to Residents or their Responsible Party. During interviews with Residents R3-R6, were asked if they pay over the amount payable for basic services of $1,398.07, four (4) out of four (4) stated they do not pay more than $1,398.07. During interviews with Residents Responsible Party W1 and W2, were asked if they pay more than the amount payable for basic services of $1,398.07, two (2) out of two (2) stated they do not pay more than $1,398.07. During the course of the investigation, LPA was unable to find evidence to support the allegation. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted with Executive Director, Carla Chan, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jan 29, 2025 · control 11-AS-20241227121421

Type of visit: Case Management - Other

On 12/16/24, the department conducted an unannounced Case Management visit to the above facility to deliver a Decision and Order for a staff exclusion. During today’s visit the department met with Administrator Carla Chan and the purpose of today’s visit was explained. The department delivered a copy of the Decision and Order (CDSS # 7923107022/OAH #2023110905). The department has excluded Staff Jonathan Menlo, and respondent is prohibited from employment in any facility licensed by the department, from presence in any facility licensed by the department, and from contact with clients from any facility licensed by the department The Order became effective December 5, 2024. The Order was provided to Administrator Carla Chan. Former Staff Jonathan Menlo was not present at the facility during the visit. Administrator stated they understand the Decision and Order and will not have Staff Jonathan Menlo present at the facility. During today's visit, the department conducted a tour of the facility. During the tour, LPA met with all staff on shift at the facility. The department confirmed, Staff Jonathan Menlo is not working at the facility. During file review, the department found that Staff Jonathan Menlo was disassociated from the facility on 01/04/24. During today’s visit the department did not observe or cite any deficiencies. An exit interview was conducted with Administrator, Carla Chan, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Dec 16, 2024

Allegation investigated: Staff does not ensure client's room is free of clutter

On 12/10/24, Licensing Program Analyst, (LPA) Felisa Shirley conducted an unannounced visit to this facility. LPA was met by Administrative Assistant, Trish Morales and explained the purpose of the visit is to investigate and deliver findings for the allegations mentioned above. LPA was granted access to the facility. The investigation consisted of the following: On 12/10/24, LPA Shirley spoke to facility Executive Director, Carla Chan and reviewed facility records. LPA requested copies of staff and resident rosters, copies of ALW program documents, Cleaning schedule, Special Incident Reports involving injuries from clutter in the rooms and special incident reports involving R-1. LPA also interviewed staff 1 thru staff 10(S1 thru S10) and residents 1 thru resident 10(R-1 thru R-10). LPA received copies of residents, Admissions Agreement, Emergency Contacts, Physician’s report, and preplacement appraisal. The investigation revealed the following: Con't on 9099-C Unsubstantiated Allegation: Staff does not ensure client’s room is free of clutter. On 12/10/24, upon arrival to this facility, LPA Shirley toured facility for a health and safety check and also inspected R-1’s room and observed that there are numerous items in which R-1 stated that she is keeping for sentimental reasons. There are concerns that these items could easily eventually become a safety hazard. LPA observed that there are clear paths to the doors, windows, bathroom and kitchenette areas. LPA Shirley reviewed R-1’s Individual’s Service Plan and learned that she is a fall risk and upon review of requested Special Incident Reports noted that R-1 has not had any falls since her admission date of 3/5/24. During interviews and a review of the House Keeping Cleaning Room Assignments, LPA learned that the resident’s rooms are cleaned on a daily basis and are deep cleaned once a week per S-2. The removal of items collected in R-1’s room is a path to achieving a room free of clutter is a journey that R-1 does not have to take alone. Per S-1, staff offers to clean the items and assist with the organization of the items, and that the cleanup process doesn’t just deal with the clutter but the emotional state of the resident while also ensuring that the resident’s personal rights are not violated. LPA Shirley spoke with and interviewed staff 1 thru staff 10 (S-1 thru S-10). LPA ask, does staff ensure resident’s rooms are free of clutter? Of those interviewed, 10 out of 10 answered, yes. LPA Shirley interviewed residents 1 thru resident 10 (R-1 thru R-10). LPA ask, does staff ensure residents rooms are free of clutter. Of those interviewed, 9 out of 10 answered yes, and 1 resident did not know. Con'd on 9099-C Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. Based on information gathered, LPA did not find sufficient evidence to support the allegation “Staff does not ensure clients room is free of clutter” therefore the allegation is unsubstantiated. No deficiencies issued during this visit. An exit interview was conducted with Administrative Assistant, Trish Morales and a copy of this report was provided.the state’s words, verbatim · CDSS document, Dec 10, 2024 · control 11-AS-20241203111041

Allegation investigated: The facility did not safeguard resident's personal property. The facility does not to give medication according to the physician's directions. The facility does not provide comfortable living accommodations for the resident.

On 08/17/24, Licensing Program Analyst (LPA) Ernand Dabuet, conducted an unannounced visit to deliver findings for the allegations listed above. LPA Dabuet met with the facility's managerJovan Caday and explained the purpose of today’s visit. Investigation consisted of the following: During a visit on 02/02/24, LPA Wendy Gibbs, conducted an unannounced subsequent complaint visit to the facility. LPA met with Executive Director, Carla Chan, and the purpose of the visit was explained. During the visit, LPA toured the facility, interviewed Staff (S3). During a visit on a 12/21/23, LPA toured the facility, interviewed Staff (S1 and S2) and Residents (R2-R10) and reviewed and received copies of pertinent documents pertaining to the investigations. The documents reviewed and received include a Staff Roster (LIC500), Resident Roster, Weekly Dining Menu, Physician’s Report, Needs and Service Plan, Centrally Stored Medications, Medication Administration Record (MAR), Appraisal, Identification and Emergency Information, and Admission Agreement. (Evaluation Report continues LIC 9099-C) Unsubstantiated INVESTIGATION REVEALED THE FOLLOWING: Allegation: The facility did not safeguard resident's personal property. The allegation alleges not all residents’ clothes are returned after laundry and staff place tight socks on their feet and male t-shirts. During an interview with R1, they stated they have had items go missing during laundry such as compression socks, shirts, and pants. R1 stated they have been put in male t-shirts which was not theirs. During interviews with Staff (S1-S7) seven out of seven (7) stated it has been a while since they have had a resident report an item missing. During interviews with staff (S1-S4) four (4) out of four (4) stated that if a resident is missing an item after laundry, staff will check with housekeeping to see if the item was left in the laundry room and if it is not there then they go help look in the resident’s room for the item. If the item is not located, they check the rooms of the other residents whose laundry was also done that day. During interviews with Staff (S3 and S4) stated each residents laundry is done separately to help minimize clothing mix-ups. LPA received and reviewed a copy of the facility’s laundry schedule. During interviews with Residents (R1-R10) two (2) out of ten (2) stated they have had items go missing. During file review, LPA received and reviewed a copy of R1’s Safeguard for Valuables and Property, which does not list any personal items on it. Allegation: The facility does not give medication according to physician’s directions. The allegation alleges staff messes up Resident medication and would like to administer their own medication. During an interview with R1 stated staff bring their medications in early and they do not want to get up that early. R1 stated they want to administer their own medications. During file review, LPA observed on R1’s Physician’s Report the physician stated, “All meds need to be administered and stored for patient.” LPA reviewed resident R1’s MAR, and observed that for the months of September, October, and November medications were administered according to the medication prescription. Additionally, during the facility visit, LPA reviewed the medication and Medication Administration Record (MAR) for ten (10) residents. (Evaluation Report continues LIC 9099-C) LPA observed ten (10) out of ten (10) resident’s MARs and medication are consistent with properly documented records. During interviews with Residents (R1-R10), were asked if they receive their medications as prescribed, seven (7) out of ten (10) stated they receive their medications as prescribed, and two (2) of the ten (10) do not receive assistance from staff administering their medications. During interviews with Staff S1-S7, were asked if residents receive their medications as prescribed, seven (7) out of seven (7) stated if the facility is managing their medications, they are provided according to the prescription label. Allegation: The facility does not provide comfortable living accommodations for the resident. The allegation alleges due to the size of their room they either eat on their commode or go downstairs to the dining room. During the interview with Residents R1-R10, were asked if the facility provided comfortable living accommodations for residents, nine (9) out of nine (9) stated they are provided with comfortable accommodations. During interviews with Staff S1-S8, were asked if residents are provided with comfortable living accommodations, eight (8) out of eight (8) stated residents are provided with comfortable accommodations. During the facility tour, LPA inspected R1’s room and observed it had the required furniture and there is open space available in the room. The bathroom door was wide enough to allow a wheelchair to fit. LPA observed ample space. During the course of the investigation, LPA was unable to find evidence to support the allegation. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are unsubstantiated. An exit interview was conducted with Jovan Caday, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Aug 17, 2024 · control 11-AS-20231214112553

Allegation investigated: Staff violated residents' personal rights by installing locks on the outside of their doors

On 6/19/2024 LPA Alfonso Iniguez conducted an unannounced complaint visit. LPA Iniguez met with Carla Chan /Administrator. LPA explained the purpose of this visit. Investigation Consisted of: LPA conducted the following interviews: Interview with Administrator (A#1), Interviews with Residents (R#1-R#9), Interviews with Facility Staff (S#1-S#5) and Interview with Witness 1 (W#1). LPA gathered the following documentation: Copies of Resident Roster and Staff Roster Copies of (R#1 and R#2) LIC 602 A and Copies if the Emergency and identification form, Copy of SRI dated 6/19/2024, and Complete tour of the facility where LPA checked room # 125 and #264. Evaluation Report continues LIC 9099-C Unsubstantiated Investigation Revealed the Following: Allegation: Staff violated residents' personal rights by installing locks on the outside of their doors The details of the complaint alleged that facility staff violated resident’s personal rights by installing locks on the outside of their doors. During the records review, LPA Iniguez observed the SRI created by the facility dated 6/19/24. It is written that on 6/18/24, an Ombudsman representative came to the facility and noticed the locks on the outside of (R#1) and (R#2) doors. (A#1) stated that she explained to the Ombudsman representative that one of the locks was placed by a family member and the other was placed per (R#2) request. Facility staff removed (R#1)’s lock and informed their representative. During a physical tour of the facility, LPA observed in room #264 a doorknob placed by the facility per the resident's request; since (R#1) is on vacation, they asked the facility administrator (A#1) to place a doorknob lock outside their room. In addition, LPA checked room #125; the lock had been removed by facility staff approximately at 9:00 AM, before LPA arrived at the facility on 6/19/24 approximately at 2:00PM. During an interview with the administrator (A#1), she stated that regarding the lock on room #125, (R#2) requested that it be placed when they are out of town. (A#1) stated that they have a copy of that key in an emergency. On the other hand, (A#1) stated that the latch lock on room #264 was removed this morning at approximately 9:00 AM prior to LPA's arrival at the facility at 2:00 PM. Evaluation Report continues LIC 9099-C During an interview with Resident 1 (R#1), they stated that she is currently out of the facility taking vacations. (R#1) indicated that they requested to put a lock on the outside of their room while they are gone. In addition, (R#1) stated that facility staff has the key for that lock. In addition, (R#1) stated that the facility staff has never violated their personal rights. During an interview with Resident 2 (R#2), they stated that they asked their son (W#1) to place that lock outside their room because they were relieved when (R#2) left the facility. (R#2) was upset because facility staff removed the lock this morning. In addition, (R#1) stated that the facility staff has never violated their personal rights. During interviews with residents (R#3-R#9), (7) out of (9) residents stated that the facility has never put a lock on their door and no facility staff has ever violated their rights. During interviews with staff (S#1-S#5), (5) out (5) facility staff stated that the facility has never placed a lock on a resident’s door without their knowledge and has never violated the rights of the residents in care. During interviews with Witness #1 (W#1), they stated that they put the lock outside of (R#2) per their request. (W#1) stated that they did not notify the facility. In addition, (W#1) stated that (A#1) called them this morning to inform them that the lock had been removed today 6/19/24. During this investigation, LPA found did not find sufficient evident to support the above-mentioned allegations. Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation(s) are found to be UNSUBSTANTIATED. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. An exit interview was conducted, and a copy of the Complaint Report was given to Carla Chan /Administrator.the state’s words, verbatim · CDSS document, Jun 19, 2024 · control 11-AS-20240619101219

Type of visit: Required - 1 Year

On 05/17/24, Licensing Program Analyst (LPA), Wendy Gibbs, conducted an unannounced annual visit to the facility listed above using the full CARE inspection tool. LPA met with Administrator, Carla Chan, and the purpose of today's visit was explained. The facility is licensed to serve ambulatory and non-ambulatory elderly adults ages 60 and above. The facility is approved for (15) hospice residents. Physical Plant/Structure The facility is a two-story structure located in a commercial neighborhood. It consists of the following: (108) resident bedrooms. Each room has a bathroom in the unit. The facility houses an activity room, dining area, kitchen, beauty shop, administrative offices, and outside patio area. There were no bodies of water or on the premises. LPA observed all walkways around the facility to be clean, clear, and free of obstructions, debris, and hazards. Rooms LPA inspected 10 resident rooms including room numbers 133, 130,127,126, 125, 235. 241, 245, 246, and 255. LPA observed rooms to be clean and in good repair. LPA observed resident rooms have the required furniture including a bed, dresser, nightstand, chair, and storage space for resident’s personal belongings. LPA observed resident beds have the required linens including a mattress cover, blanket, comforter, and pillows. LPA observed an ample supply of linens in good condition. LPA observed rooms to have ample lighting. CONTINUED ON LIC9099-C Bathrooms LPA inspected bathrooms in rooms. Bathrooms were found to be within Title 22 Regulations and were operational. All bathroom inspected have secured safety handrails, shower mats, and a shower chair. LPA observed an ample supply of towels in good condition. LPA observed an ample supply of hygiene products. The water temperature measured between 117.3-degrees and 119.8-degrees Fahrenheit. Common Rooms LPA observed the facility to be sanitary and appropriately furnished at the time of the visit. During facility visit, LPA observed residents participating in morning exercise in the activity room. There is a game area that consists of a pool table, puzzles, games, and activities. LPA observed multiple seating areas for residents. LPA observed the dining rooms have ample seating to accommodate all residents. LPA observed all walkways and hallways were clean, clear, and free of obstructions and hazards. All hallways and rooms were observed with ample lighting. Kitchen LPA inspected the commercial kitchen and found it to be clean and sanitary. LPA observed all appliances to be operable and in good repair. LPA observed an ample supply of dishware, cookware, and cutleries in good repair. LPA observed a 3-day supply of perishable foods and a 7-day supply of non-perishable foods properly labeled, stored, and dated. CONTINUED ON LIC9099-C Safety LPA observed several fire extinguishers fully charged. The last emergency drill was conducted on 04/16/24 for all shifts. Smoke and carbon monoxide detectors are operational. LPA tested call button and found them to be in operating condition. The facility has multiple working landline telephones on-site. LPA observed storage area for personal hygiene, cleaning supplies, toxins, and sharps are secured and inaccessible to residents. LPA observed all required documents posted in the facility. Medications LPA observed Centrally Stored Medication secured in a medication cart locked in the med room. All medications were observed in their original packaging. LPA reviewed the medication for ten (10) residents and the Medication Administration Record and found they were consistent with properly documented records. Files/Interviews LPA reviewed the files for 7 residents and found they contained the required documents. LPA interviewed 5 residents, and all were happy with the care they receive from the facility staff. LPA reviewed 5 staff files and observed they had the required documents, certification, and training. LPA interviewed 4 staff, and all were able to answer questions regarding policy, procedure, resident’s rights, and resident care. The Administrator Certificate is valid till 05/25/25. LPA observed during file review that the Licensing fees are up to date. LPA received a copy of the facility’s Liability Insurance. CONTINUED ON LIC-9099-C Infection Control During the visit LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas and restrooms. LPA observed the facility has a 120-day supply of Personal Protective Equipment (PPE). All mandated infection control posters were posted. No Deficiencies were observed or cited during this inspection visit. An exit interview was conducted with Administrator, Carla Chan, and a copy of this report was provided.the state’s words, verbatim · CDSS document, May 17, 2024

Allegation investigated: Staff did not seek medical attention for resident in a timely manner.

On 03/28/24, Licensing Program Analyst (LPA) Ernand Dabuet conducted an initial complaint visit at this facility. LPA met with Administrator Carla Chan. LPA explained the purpose of the visit was to investigate the allegation mentioned above. The investigation consisted of the following: Interviews with administrator #1 (A1), staff #1 -# (S1-S3), residents #1-#10 (R1-R10), and witnesses #1-#5 (W1-W5). Review of the staff and resident rosters, Resident #1 (R1)Admission Agreement, Resident Assessment, Physician's Report, Unusual Incident Reports LIC 624, Identification and Emergency Information LIC 601, and other pertinent documents associated with the complaint. A plant inspection was conducted. (Evaluation Report continues LIC 9099) Unsubstantiated INVESTIGATION REVEALED THE FOLLOWING: Allegation: Staff did not seek medical attention for resident in a timely manner. The details of the complaint alleged resident #1 (R1) sustained a fall on 03/19/24. The complainant claimed (R1) fell but was fine. (R1) fell again on 3/21/24 and was on the ground for a couple of hours with dried blood. The facility failed to seek prompt medical attention. The complainant reported the owner Maria who refused to call 911 and that companions of (R1) ended up calling for a medic unit. On 03/22/24, resident #1 (R1) was admitted to Torrance Memorial Medical Center for general weakness according to an Unusual Incident Report LIC 624 (dated: 03/25/24). On 03/20/24, an Unusual Incident Report (dated: 03/25/24) reported (R1) had an unwitnessed fall, and it went unreported. During (R1's) fall, he was on the bed at the foot of the bed. (R1) did not think of informing a staff as (R1) did not feel pain or sustained injury. (R1) claimed to be able to drag self-back to bed with no required assistance. On 03/28/24 between 09:50 am – 11:10 am, the Department interviewed administrator (A1) and (3) out (3) staff #1-#3 (S1-S3). (A1 and S1) stated they were both made aware of the unwitnessed fall incident that occurred with (R1) and that immediate medical attention was provided. (A1 and S1) claimed that (R1) is not considered a fall risk and did not require 24/7 one-on-one supervision according to (R1's) Physician’s Report (dated: 07/07/22) and Resident Assessment (dated: 11/21/23). (S1) described that in the early hours of 03/20/24, (S2) notified (S1) that (R1) did not want to participate in breakfast as (R1) had fallen during the evening shift and did not report or use (R1’s) call button to alert staff for the incident. (S1-S3) who observed (R1) on 03/20/24, reported that (R1) did not have external injuries or appeared with lacerations, scraps, bruises, or bleeding cuts on (R1’s) body. (S3) claimed to have assisted (R1) before 12:00 pm on 03/20/24 with toileting and grooming and conducted a body check and did not observe any wounds, bruising, or bleeding cuts on (R1). (A1 and S1) confirmed (R1’s) power of attorney and the medical doctor was notified immediately of the incident and that medical assistance was offered, however, refused to be evaluated by (R1’s) primary physician. (S2-S3) stated that (R1) is monitored (4) times a day as indicated on (R1's) Residents Assessment and that all care staff has completed Quarterly In-Service Training on "Unusual Incident Reporting and Protocol" (dated: 12/25/23 and 03/26/24). (Evaluation Report continues LIC 9099-C) (A1) disputed the information provided by the complainant is inaccurate. (R1) did not have a second fall on 03/21/24. There was no evidence of dried blood anywhere. There is no owner named Maria. According to (A1), (R1) consumes cranberry juice and has allegedly stained bedsheets with cranberry juice contents that looked similar to blood stains. (A1 and S1) claimed that it was the facility that contacted Emergency Medical Services (Medreach Ambulance Services) on 03/22/24 for (R1’s) emergency service transport. The (EMS) call was requested for (R1's) weakness condition and not for the fall that occurred on 03/20/24. It was clarified that it was not the family companions that made the call to 911. On 03/28/24 between 11:20 am – 1:37 am, the Department interviewed the power of attorney for (R1) witness #1 (W1) who verified that (S2) had informed (W1) by telephone and text messages of (R1’s) fall on 03/19/24 and (R1’s) refusal to seek medical treatment from (R1’s) primary physician. The communication between (W1) and (S1) can be seen in the text messages provided as evidence by (S1) (dated: 03/20/24). (W1) visited (R1) at the hospital and found no external injuries, such as lacerations, scrapes, bruises, or bleeding cuts on (R1). On 03/28/24 between 12:45 pm and 12:55 pm, the Department interviewed (R1’s) primary physician’s office staff witness #2 (W2) who verified on 03/20/24 at 10:48 am, (S1) contacted the office to report that (R1) had unwitnessed fall and refused to be medically evaluated by the physician. As a result of the fall and (R1) refused to be medically evaluated, it was recommended that the facility staff monitor (R1’s) condition. On 03/25/24 between 03:10 pm – 03:24 pm, the Department interviewed hospital social worker witness #3 (W3) from Torrance Memorial Medical Center who verified that (R1) was examined and did not sustain a fracture or any internal or external injuries. (R1) did not have any apparent head injury, lacerations, bruises, or bleeding due to the fall. On 03/28/24 between 01:30 pm – 02:59 pm, the Department interviewed (9) out of (9) residents #2-#10 (R2-R10) and claimed that facility staff are responsive to provide prompt medical assistance. (R7-R10) reported that staff were immediately able to assist them when they fell at the facility. (R2-R10) all expressed positive attitudes toward staff and had no concerns about their health or safety. (Evaluation Report continues LIC 9099-C) Residents #1 (R1) and (R1's) companions (W4-W5) were contacted by telephone but did not respond and were unable to provide any information. Based on the information gathered, an inspection of the facility, observation, and interviews conducted, an analysis of records reviewed, the Department found no evidence to support NEGLECT/LACK OF CARE Staff did not seek medical attention for resident in a timely manner. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation, did or did not occur, therefore the allegation is Unsubstantiated. An exit interview conducted with Carla Chan and copies of this report was provided.the state’s words, verbatim · CDSS document, Mar 28, 2024 · control 11-AS-20240322135212

Allegation investigated: The facility does not provide comfortable room temperatures. The facility staff does not have the ability to communicate with residents The facility does not make menu available for review by the residents.

On 02/02/24, Licensing Program Analyst (LPA), Wendy Gibbs, conducted an unannounced subsequent complaint visit to the facility listed above. LPA met with Executive Director, Carla Chan, and the purpose of today's visit was explained. During today's visit, LPA toured the facility, interviewed Staff (S3-S8) and received and reviwed housekeeping laundry schedule, additional resident MARs, and AC Unit rooms. On a 12/21/23, LPA toured the facility, interviewed Staff (S1 and S2) and Residents (R2-R10) and reviewed and received copies of pertinent documents pertaining to the investigations. The documents reviewed and received include a Staff Roster (LIC500), Resident Roster, Weekly Dining Menu, Physician’s Report, Needs and Service Plan, Centrally Stored Medications, Medication Administration Record (MAR), Appraisal, Identification and Emergency Information, and Admission Agreement. Continued on LIC9099-C Unsubstantiated Allegation: The facility does not provide comfortable room temperatures. The allegation alleges when resident turns the temperature up staff ask them to turn it down because other residents are hot resulting in the resident being cold. During an interview with Staff S1 stated rooms do not have their own heater or AC and that 5 to 6 rooms are controlled by one thermostat in a resident’s room. During the tour of the facility, LPA checked the temperature of thermostats in common areas. LPA observed the following thermostats and their settings set at: activity room 73-degrees, lobby 76-degrees, sitting lounge 74-degrees, music room 73-degree, dining room 72-degrees, upstairs activity room and lounge was set at 73-degrees Fahrenheit. Additionally, during the facility tour LPA inspected rooms that housed the thermostat controls and observed the following in room 128 the temperature was set at 72- degrees, in room 107 the temperature was set at 74-degrees, in room 251 the temperature was set at 76-degrees and in room 217- the temperature was set at 76-degrees Fahrenheit. During interviews with R1, they stated they have the thermostat controls in their room, and it is connected to other rooms. R1 states when they are cold, they turn the heat up and staff come in an ask to turn it down due to the other residents being hot, resulting in R1 being cold. During the tour LPA observed the thermostat connected to their room was set at 76-degrees Fahrenheit. During interviews with Residents (R1-R10) five (5) out of ten (10) stated the facility is kept at a comfortable temperature, two (2) residents stated it is sometimes warm, one (1) resident stated it is sometimes cold at night, and two (2) stated it sometimes too warm then other Continued on LIC9099 residents open their slider and a cold breeze comes in. During interviews with Staff (S1-S8), eight (8) out of eight (8) stated the temperature is maintained at a comfortable temperature. During visits at the facility, LPA observed the temperature to be comfortable in the facility. During the course of the investigation, LPA was unable to find any evidence supporting the allegation. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the above allegation did or did not occur, therefore the allegation is unsubstantiated. Allegation: The facility staff does not have the ability to communicate with residents. The allegation alleges staff do not speak English well enough for Resident to understand. During interviews with Residents (R1-R10), nine (9) out of ten (10) stated they have no concerns regarding staff’s ability to communicate with residents. During interviews with Staff (S1-S8) eight (8) out of eight (8) stated they do not have any issues communicating with residents and are able to understand residents needs and concerns. During LPA’s visit to the facility, LPA observed residents and staff communicating without issues. Residents were observed expressing their needs or concerns to staff and they were receiving assistance they requested. LPA observed breakfast and lunch being served at the facility. LPA observed kitchen staff communicating with residents regarding the menu and any special requests Continued on LIC9099 residents had. LPA did not observe any issues with communication between staff and residents. During the course of the investigation, LPA was unable to find any evidence supporting the allegation. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the above allegation did or did not occur, therefore the allegation is unsubstantiated. Allegation: The facility does not make menu available for review by the residents. The allegation alleges staff does not provide a food menu to Resident. During the tours of the facility, LPA observed the weekly meal menu posted at the front and rear entrance of the dining room. Additionally, when LPA asked S7 for a copy of the menu they opened a drawer in the front desk and pulled out copies and provided LPA with a copy. During interviews with Residents (R1-R10) nine (9) out of ten (10) stated the weekly menu is posted near the front and rear entrance of the dining room and menus are provided to residents by staff and available anytime at the front desk. During interviews with Staff (S1-S8), eight (8) out of eight (8) stated the facility menu is posted at the front and rear entrance of the dining room and menus are provided to residents who want one. During the course of the investigation, LPA was unable to find any evidence supporting the allegation. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the above allegation did or did not occur, therefore the allegation is unsubstantiated. During today's visit LPA did not observe or cite any deficiencies. An exit interview was conducted with Executive Director, Carla Chan, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Feb 2, 2024 · control 11-AS-20231214112553

The state marks this report as 6 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.